Carolyn Jacoby Gabbay represents providers of health care services and senior living options (such as hospitals, physicians, life care and continuing care retirement communities, long-term care and home health providers) before state and federal regulatory agencies and in their strategic transactions, in payment matters (including sophisticated managed care risk contracting and ACO development) and in their ongoing business operations.
My current practice focus is on three key areas, leveraging my 35+ years of experience representing health care and senior living/post-acute providers to add value in their sophisticated transactions.
I advise health care systems in their strategic affiliations and transactions representing hospitals forming regional health systems with community hospitals and academic medical centers; IPAs creating affiliated, regional contracting networks; and senior living, post-acute and home health providers aligning to reposition as part of accountable care organizations. For example, recently, my team successfully represented a health care system that was the “stalking horse” bidder in a state court receivership on the acquisition of the assets and operations of a community hospital in a neighboring state. The transaction was named “Deal of the Year – Healthcare/Life Sciences Sector” by M&A Advisor.
I counsel providers on internal investigation of compliance issues; represent them in the self-disclosure of Stark, Anti-Kickback and billing compliance matters; and negotiate resolutions with the Office of Inspector General (OIG) and the United States Department of Justice. For example, I have worked with the OIG before filing a formal self-disclosure to assure the investigative plan and random sampling would be accepted under the new Voluntary Disclosure Protocol.
I have extensive experience with a wide array of managed care risk and incentive arrangements, including value-based contracts, percentage of premium, global capitation, budgeted capitation, bundled payments, P4P, quality incentives and shared savings arrangements with third-party payors for commercial and Medicare Advantage products as well as the Medicare ACO population management program (including Pioneer ACOs). I helped a state-wide integrated delivery system develop a cutting-edge economic partnership with a commercial insurer to issue a new signature, system-centric health insurance product for the small employer and individual market. I am also helping clients inform state regulatory agencies as they wrestle with addressing the growing prominence of risk-bearing organizations.
Providers will face tremendous pressure to accept constantly increasing amounts of economic performance risk and to create collaborations and partnerships across the continuum of care in a wide variety of healthcare and living settings. I am working with forward-thinking health care organizations on creative risk-bearing strategies to embrace this challenge and realize on its opportunities.
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Boston University School of Law, J.D., cum laude
Boston University, B.A., summa cum laude, Phi Beta Kappa
U.S. Tax Court
Carolyn Jacoby Gabbay was selected by her peers for inclusion in The Best Lawyers in America© 2018 in the field of Health Care Law. Carolyn has been listed in Best Lawyers since 2013.
Ms. Gabbay has also been recognized for exceptional standing in the legal community for health care work in Chambers USA: America’s Leading Lawyers for Business each year from 2007-present. She has also been selected for inclusion in Massachusetts Super Lawyers from 2004–present, based on peer-review surveys.
Ms. Gabbay has received an AV Preeminent® Peer Review Rating™ from Martindale Hubbell®, the highest possible rating for ethics and legal ability.
In 2014, Massachusetts Lawyers Weekly named Ms. Gabbay among the 2014 “Top Women of Law.” The Massachusetts-Rhode Island Chapter of the Health Care Financial Management Association also awarded Ms. Gabbay its Medal of Honor as well as the Frances M. Hernan Merit Award for Outstanding Contributions to the Field of Health Care Financial Management. Twice she has been awarded the Nixon Peabody’s William Rodman Peabody Award for Outstanding Pro Bono Service.
Carolyn Jacoby Gabbay is a frequently invited speaker before professional groups such as hospital boards of trustees and medical staffs, the Healthcare Financial Management Association (including educational programs of the Massachusetts, Rhode Island, and Vermont/New Hampshire chapters), the Massachusetts Hospital Association, the Health Care Management Association, the American Academy of Neurology, and the U.S. Department of Labor. She has been a faculty member of the New England Healthcare Assembly’s Healthcare Trustee Institute.
Carolyn Jacoby Gabbay is also president of the Victor Herbert Foundation, a private foundation supporting the arts and other charitable causes.